Spinal anaesthesia for Caesarean section in patients with COVID can be provided safely, although anaesthetists are at risk of infection, significantly reduced by use of Level 3 PPE (PAPR + protective suit).

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• Qi Zhong, Yin Y Liu, Qiong Luo, Yu F Zou, Hai X Jiang, Hui Li, Jing J Zhang, Zhen Li, Xin Yang, Min Ma, Li J Tang, Ying Y Chen, Feng Zheng, Jian J Ke, and Zong Z Zhang.
• Department of Anaesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China.
• Br J Anaesth. 2020 Jun 1; 124 (6): 670-675.

BackgroundThe safety of performing spinal anaesthesia for both patients and anaesthetists alike in the presence of active infection with the novel coronavirus disease 2019 (COVID-19) is unclear. Here, we report the clinical characteristics and outcomes for both patients with COVID-19 and the anaesthetists who provided their spinal anaesthesia.MethodsForty-nine patients with radiologically confirmed COVID-19 for Caesarean section or lower-limb surgery undergoing spinal anaesthesia in Zhongnan Hospital, Wuhan, China participated in this retrospective study. Clinical characteristics and perioperative outcomes were recorded. For anaesthesiologists exposed to patients with COVID-19 by providing spinal anaesthesia, the level of personal protective equipment (PPE) used, clinical outcomes (pulmonary CT scans), and confirmed COVID-19 transmission rates (polymerase chain reaction [PCR]) were reviewed.ResultsForty-nine patients with COVID-19 requiring supplementary oxygen before surgery had spinal anaesthesia (ropivacaine 0.75%), chiefly for Caesarean section (45/49 [91%]). Spinal anaesthesia was not associated with cardiorespiratory compromise intraoperatively. No patients subsequently developed severe pneumonia. Of 44 anaesthetists, 37 (84.1%) provided spinal anaesthesia using Level 3 PPE. Coronavirus disease 2019 infection was subsequently confirmed by PCR in 5/44 (11.4%) anaesthetists. One (2.7%) of 37 anaesthetists who wore Level 3 PPE developed PCR-confirmed COVID-19 compared with 4/7 (57.1%) anaesthetists who had Level 1 protection in the operating theatre (relative risk reduction: 95.3% [95% confidence intervals: 63.7-99.4]; P<0.01).ConclusionsSpinal anaesthesia was delivered safely in patients with active COVID-19 infection, the majority of whom had Caesarean sections. Level 3 PPE appears to reduce the risk of transmission to anaesthetists who are exposed to mildly symptomatic surgical patients.Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

This article appears in the collection: Anaesthesiology, Personal Protective Equipment (PPE) and COVID.

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